scholarly journals Feasibility of Implementing a Breast Reconstruction Database

2018 ◽  
Vol 27 (1) ◽  
pp. 38-43
Author(s):  
Connor R. McGuire ◽  
Laura Allen ◽  
Martin R. LeBlanc
Keyword(s):  
Breast Reconstruction ◽  
Tertiary Care ◽  
National Database ◽  
Care Hospital ◽  
Database Construction ◽  
Practice Characteristics ◽  
Commitment Cost ◽  
Academic Center ◽  
Time Required ◽  
The Cost

Objective: To assess whether implementing a breast reconstruction database would be feasible in terms of time commitment, cost, and overall benefits in a tertiary-care hospital. Methods: A survey was sent to 40 Canadian plastic surgeons who have a practice focused on breast reconstruction. The survey assessed demographics, practice characteristics, database use, and opinions on database construction. Univariate descriptive analyses were performed on all variables. Results: Thirty-one surgeons responded to the survey (77.5%). Most were from Ontario (29.1%) and worked in an academic center (83.9%). Of all, 45.3% of surgeons performed more than 50 breast reconstructions yearly. Six (19.4%) surgeons utilized databases that were all started for quality improvement and research purposes. Databases included variables such as demographics, type of reconstruction, complications, surgeons involved, and type of implants. Data are input by research assistants (50%) for approximately 4.2 hours per month at a cost below 200$CAD per month. Databases are funded by research grants (50%), hospital funds (33.3%), and/or division funds (16.7%). Of the surgeons without databases, 60% have considered starting a database. Barriers include being too busy (72%) and impressions of the cost being too high (32%). Surgeons commonly felt that a database would be beneficial at their practice (80%), provincially (77.4%), and nationally (67.7%). Conclusions: Plastic surgeons are open to the idea of constructing a breast reconstruction database and that the costs and time required are lower than expected. Grants or integration with existing databases should be pursued on a provincial level first prior to pursuing a national database.

scholarly journals Surgical Pathology Resident Rotation Restructuring at a Tertiary Care Academic Center

2017 ◽  
Vol 4 ◽  
pp. 237428951773634
Author(s):  
Chelsea R. Mehr ◽  
Amrom E. Obstfeld ◽  
Amanda C. Barrett ◽  
Kathleen T. Montone ◽  
Lauren E. Schwartz
Keyword(s):  
Resident Education ◽  
Tertiary Care ◽  
Turnaround Time ◽  
Surgical Pathology ◽  
Primary Sources ◽  
Road Map ◽  
Academic Center ◽  
Organ Systems ◽  
Before And After ◽  
Time Required

Changes in the field of pathology and resident education necessitate ongoing evaluation of residency training. Evolutionary change is particularly important for surgical pathology rotations, which form the core of anatomic pathology training programs. In the past, we organized this rotation based on subjective insight. When faced with the recent need to restructure the rotation, we strove for a more evidence-based process. Our approach involved 2 primary sources of data. We quantified the number of cases and blocks submitted per case type to estimate workload and surveyed residents about the time required to gross specimens in all organ systems. A multidisciplinary committee including faculty, residents, and staff evaluated the results and used the data to model how various changes to the rotation would affect resident workload, turnaround time, and other variables. Finally, we identified rotation structures that equally distributed work and created a point-based system that capped grossing time for residents of different experience. Following implementation, we retrospectively compared turnaround time and duty hour violations before and after these changes and surveyed residents about their experiences with both systems. We evaluated the accuracy of the point-based system by examining grossing times and comparing them to the assigned point values. We found overall improvement in the rotation following the implementation. As there is essentially no literature on the subject of surgical pathology rotation organization, we hope that our experience will provide a road map to improve pathology resident education at other institutions.

scholarly journals A comparative study for production of germ tube in Candida albicans of various pulmonary samples, by different methods in a tertiary care hospital of south west Rajasthan

2021 ◽  
Vol 8 (12) ◽  
pp. 5968
Author(s):  
Upasana Bhumbla ◽  
Amit Gupta
Keyword(s):  
Candida Albicans ◽  
Germ Tube ◽  
Tertiary Care ◽  
Public Health Issue ◽  
Care Hospital ◽  
Tube Production ◽  
Easy Method ◽  
Yeast Extract Peptone Dextrose ◽  
Sugar Fermentation ◽  
Time Required

Background: Systemic candidiasis is associated with a high crude mortality rate, even with first line antifungal therapy. C. albicans is the predominant cause of invasive fungal diseases which is a serious public health issue. The main objective was to assess the reliability of different media for germ tube production in Candida albicans isolated from various clinically diagnosed pulmonary samples.Methods: All Candida isolates were identified and speciated by conventional methods such as Gram’s staining, germ tube test, chlamydospore formation on corn meal agar, sugar fermentation test, sugar assimilation test, and growth on Hi-chrome candida agar.Results: Out of 108 clinical isolates of Candida albicans, 5 different methods were used for germ tube production. Pooled human sera showed 93/108 (86.1%) was the most sensitive method wherein YEPD (yeast extract peptone dextrose) broth 91/108 (84.7%) was the reliable and easy method for detection of germ tube, followed by trypticase soy broth 81/108 (81.4%); peptone water 80/108 (74.7%) and 2% sucrose 71/108 (65.7%).Conclusions: YPED broth is found to be a better serum free substrate and subsequently for the presumptive differentiation of C. albicans from non-albicans candida (NAC), without the extensive time required for the preparation and testing of pooled human serum. Furthermore, this medium is commercially available, more stable, effective, and is not bio hazardous.

Costs of Management of Occupational Exposures to Blood and Body Fluids

2007 ◽  
Vol 28 (7) ◽  
pp. 774-782 ◽  
Author(s):  
Emily M. O'Malley ◽  
R. Douglas Scott ◽  
Julie Gayle ◽  
John Dekutoski ◽  
Michael Foltzer ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Occupational Exposures ◽  
Body Fluids ◽  
Healthcare Personnel ◽  
Care Hospital ◽  
Infection Status ◽  
Convenience Sample ◽  
The Cost ◽  
Mean Cost

Objective.To determine the cost of management of occupational exposures to blood and body fluids.Design.A convenience sample of 4 healthcare facilities provided information on the cost of management of occupational exposures that varied in type, severity, and exposure source infection status. Detailed information was collected on time spent reporting, managing, and following up the exposures; salaries (including benefits) for representative staff who sustained and who managed exposures; and costs (not charges) for laboratory testing of exposure sources and exposed healthcare personnel, as well as any postexposure prophylaxis taken by the exposed personnel. Resources used were stratified by the phase of exposure management: exposure reporting, initial management, and follow-up. Data for 31 exposure scenarios were analyzed. Costs were given in 2003 US dollars.Setting.The 4 facilities providing data were a 600-bed public hospital, a 244-bed Veterans Affairs medical center, a 437-bed rural tertiary care hospital, and a 3,500-bed healthcare system.Results.The overall range of costs to manage reported exposures was $71-$4,838. Mean total costs varied greatly by the infection status of the source patient. The overall mean cost for exposures to human immunodeficiency virus (HIV)-infected source patients (n = 19, including those coinfected with hepatitis B or C virus) was $2,456 (range, $907-$4,838), whereas the overall mean cost for exposures to source patients with unknown or negative infection status (n = 8) was $376 (range, $71-$860). Lastly, the overall mean cost of management of reported exposures for source patients infected with hepatitis C virus (n = 4) was $650 (range, $186-$856).Conclusions.Management of occupational exposures to blood and body fluids is costly, the best way to avoid these costs is by prevention of exposures.

scholarly journals AN EVALUATION ON PRESCRIBING PATTERN OF ANTIBIOTICS IN PAEDIATRIC INPATIENTS AT TERTIARY CARE HOSPITAL

2019 ◽  
pp. 53-57
Author(s):  
SABISHRUTHI S ◽  
KAVITHA S ◽  
JAGAN NATHAN B ◽  
KALICHETI PRIYANKA ◽  
ARSHATH A
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Minimum Cost ◽  
Prescribing Patterns ◽  
Care Hospital ◽  
Sensitivity Testing ◽  
Prescribing Pattern ◽  
Case Record ◽  
Tract Infections ◽  
The Cost

Objective: Our objective of the study was to evaluate the prescribing patterns of drugs with cost analysis in pediatric inpatients at tertiary care hospital. Methods: It is an observational prospective study carried out in pediatric inpatients with a sample of 180 patients based on age, inclusion, and exclusion criteria for period of 3 months. The patient’s data were collected using patient case record form and analysis of the data was done. Results: Of 180 patients data were collected, the results show that majority of gender admitted in the hospital were male children 94 (52%) and many are from age group of early childhood (2–5 years) 67 (37%). Respiratory tract infections are diagnosis most commonly analyzed and off overall 236 prescribed antibiotics cephalosporins 86 (43%) and combination of amoxicillin + clavulanic acid 25 (71%) is the class of antibiotics prescribed higher than other class of drugs. Parental 173 (73%) route of administration was observed to be followed more than other route. The percentage of cost variation of antibiotics observed in the study reveals that the huge variations were seen in the cost of medication in maximum and minimum cost. Conclusion: The present study reveals that the prescribed antibiotics were as per the diagnosis of the patient and not by proceeding proper culture sensitivity testing. Hence, awareness about antibiotic must be created among practicing physicians to increase the therapeutic compliance of the patient.

scholarly journals Need for teleconsultation among the emergency medicine and critical care personnel during pre-hospital transport in a tertiary care unit

2017 ◽  
Vol 4 (1) ◽  
pp. 176
Author(s):  
V. Karunai Kadhir ◽  
T. Hemalatha ◽  
V. P. Chandrasekaran
Keyword(s):  
Emergency Medicine ◽  
Treatment Guidelines ◽  
Improve Patient Safety ◽  
Prehospital Care ◽  
Tertiary Care ◽  
Minimum Time ◽  
Care Hospital ◽  
Cross Sectional ◽  
Significant Difference ◽  
Time Required

Background: Time being the most crucial factors in emergency medicine, teleconsultation enables patient assessment by specialists, immediate reception of appropriate treatment guidelines until the patient's arrival at hospital.Methods: Our study evaluated the need for teleconsultation among the emergency physicians (EP) and emergency technicians (ET) in a tertiary care hospital. Cross-sectional study conducted in Department of Emergency Medicine, a tertiary care setting. Pretested semi-structured questionnaire was given to EP and ET. Various parameters like the need for teleconsultation, the minimum time required for EMS (emergency medical services) to arrive at the scene and to the hospital, effectiveness of teleconsultation in prehospital care were evaluated.Results: SPSS version 18.0 was used. 24 EP and 36 ET participated in the study. The minimum time required for the EMS to arrive at the scene and then to hospital was calculated indirectly to be > 30 min. There was a significant difference among the EP an ET in interpreting common emergency condition p = 0.029 and criticality assessment p=0.035.The training of EMS staffs was adequate. Both EP and ET were able to adhere recent guidelines during prehospital transport. All the study participants (100%) felt the need for teleconsultation which would improve the patient management during the prehospital period.Conclusions: Teleconsultation has the potential to improve patient safety and quality of treatment in a prehospital setting and should be further evaluated.  

scholarly journals Cost effectiveness analysis in the management of stroke in a tertiary care hospital

2019 ◽  
Vol 8 (11) ◽  
pp. 2566
Author(s):  
Gargi Dey ◽  
Jyothi R. ◽  
Girish K.
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Socioeconomic Group ◽  
Early Management ◽  
Effectiveness Analysis ◽  
The Mean ◽  
The Cost ◽  
Mean Cost

Background: Stroke has a high economic impact on the society especially in a developing country like India. In India health insurance doesn’t cover all people leading to out of pocket expenditure. The objective of the present study was to study the cost of illness and outcome of stroke in a tertiary care hospital.Methods: Direct medical and nonmedical costs were obtained after 28 days of follow-up. The outcome of the stroke was measured by modified Rankin scale (mRS).Results: The mean age of the patients was 65.38±13.98 years. Majority of the patients suffered from ischemic stroke and belonged to lower middle socioeconomic group. The mean cost of stroke was INR 39819. There was improvement in the mRS score after 28 days following treatment of acute stroke.Conclusions:Direct medical costs forms major component of cost of stroke. Early management and hospital discharge can reduce the economic burden of stroke. 

scholarly journals Study of the Variation in Prices of Antidepressant Drugs Available in Nepali Market

2020 ◽  
Vol 5 (2) ◽  
pp. 1006-1010
Author(s):  
Anjan Khadka ◽  
Pradeep Manandhar ◽  
Nagendra Katuwal ◽  
Mahesh Khatri
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Antidepressant Drugs ◽  
Cost Ratio ◽  
Care Hospital ◽  
Cross Sectional ◽  
Medical Specialties ◽  
Cost Variation ◽  
Multiple Drugs ◽  
The Cost

Introduction: Depression often remains unrecognized, misdiagnosed and/or under treated. There are multiple drugs from multiple companies which are available for treatment of depression. The prices of same drug with different brands are variable which questions the afford ability of treatment to the patients and their compliance. Objective The study was conducted to analyze the cost variation of different brands of antidepressant drugs prescribed in a tertiary care hospital of Nepal. Methodology This study design was cross-sectional and method was quantitative method and conducted at department of pharmacology of a tertiary care hospital from September 2018 to January 2019 after getting approval from institutional review committee. The commonly prescribed antidepressant drugs were recorded from prescription records of department of psychiatry and their cost, cost ratio and percentage variation were calculated as per current index of medical specialties and National index of medical specialties. The data were recorded in MS excel and presented as simple descriptive statistics. Result The study included seven commonly prescribed antidepressants obtained from 214 prescription records. The cost of one course of citalopram 40 mg tablet was found to be higher and the cost of one course of imipramine 25 mg tablet was found to be lower. The maximum and minimum cost ratio was 2.46 and 1.08 with fluoxetine 20 mg capsule and dothiepin 50 mg tablet respectively. The maximum and minimum percentage of cost variation was with fluoxetine 20 mg capsule and dothiepin 50 mg tablet. Conclusion Costs of antidepressants had wider variations depending on the manufacturers and availability of different dose and brands.

scholarly journals Diagnosis Pattern and Outcome of Adolescents Admitted with Recurrent Abdominal Pain in a Tertiary Care Hospital

2017 ◽  
Vol 41 (1) ◽  
pp. 4-8
Author(s):  
Hossain Sahid Kamrul Alam ◽  
Mohammed Rizwanul Ahsan ◽  
Md Aynal Hoque ◽  
Abm Mahfuz Hassan Al Mamun ◽  
Syed Shafi Ahmed
Keyword(s):  
Abdominal Pain ◽  
Inflammatory Diseases ◽  
Tertiary Care ◽  
Abdominal Tuberculosis ◽  
Recurrent Abdominal Pain ◽  
Care Hospital ◽  
Functional Abdominal Pain ◽  
Management Protocol ◽  
History Of ◽  
The Cost

Background: Abdominal pain is very common among children and adolescents. There are many causes of recurrent abdominal pain in children, but parents may find it surprising that it is very common for there to be no clear cause identified for childhood abdominal pain even though examinations and tests have been done.Objective: This study was carried out to identify the demographic profile, causes and outcomes of adolescents admitted with recurrent abdominal pain.Methods: This Retrospective descriptive study was carried out at the Adolescent Unit of Dhaka Shishu (Children) Hospital during the period from 1st October 2015 to 31st March 2017 among 102 adolescents with history of recurrent abdominal pain after following the inclusion and exclusion criteria. Collected data were statistically analyzed with the use of the Statistical Package for Social Science (SPSS) program version 15.Results: Out of 1080 total 102 (9.44%) adolescents were admitted with recurrent abdominal pain of which majority subjects were male (57%). Urban were 61.76% and rest were rural (38.24%). The specific diagnosis pattern revealed that majority had Functional abdominal pain (44.12%) followed by Urinary tract infection (UTI) (20.59%), Peptic ulcer diseases (13.73%), Gastroesophagial reflux diseases (GERD) (11.76%), Abdominal tuberculosis (5.88%), Pelvic inflammatory diseases (4.90%), Cholecystitis (1.96%) and Abdominal migraine (0.98%).Conclusion: Recurrent abdominal pain is common among adolescents. Functional abdominal pain is the most common cause of recurrent abdominal pain. An uniform management protocol should be developed for proper investigations to minimize the cost and for judicious use of drugs in order to help these adolescents with recurrent abdominal pain.Bangladesh J Child Health 2017; VOL 41 (1) :4-8

Disparities in Rural Breast Cancer Care: Factors Affecting Choice of Breast Reconstruction in a West Virginia Tertiary Care Hospital

2017 ◽  
Vol 83 (7) ◽  
pp. 717-721 ◽  
Author(s):  
Tyler L. Holliday ◽  
Patrick D. Suggs ◽  
Stephanie N. Thompson ◽  
Bryan K. Richmond
Keyword(s):  
Breast Cancer ◽  
West Virginia ◽  
Breast Reconstruction ◽  
Rural Population ◽  
Early Stage ◽  
Tertiary Care ◽  
The United States ◽  
Care Hospital ◽  
Unilateral Breast Cancer ◽  
Insurance Type

The decision to pursue immediate postmastectomy breast reconstruction (IBR) is not uniform across all groups of women in the United States. We sought to investigate if the challenges of caring for a socioeconomically and geographically challenged rural population affected the incidence of IBR and to identify predictive factors of IBR in this population. Using our institution's cancer registry, we conducted a 10-year review of women with early-stage, unilateral breast cancer who received mastectomy. Demographics, insurance status, comorbidities, and surgeon graduation year were compared for patients receiving IBR versus no reconstruction. Variables with P < 0.05 on univariate analysis were included into a multivariate logistic regression model to determine independent predictors of IBR. From 2006 to 2015, 53/423 (12.5%) patients underwent IBR. On multivariate analysis, three factors independently predicted the decision to undergo IBR: age (P = 0.004), insurance type (P = 0.034), and use of contralateral prophylactic mastectomy (CPM, P < 0.001). Our data indicate that age, insurance type, and utilization of CPM influence the decision to pursue reconstruction. Additionally, the rate of IBR was found to be much lower in our West Virginia population than reported nationally, suggesting disparities in the care of women with early-stage, unilateral breast cancer in a rural population, even in a tertiary care environment.

scholarly journals The Cost of Pre-Analytical Errors in INR Testing at a Tertiary-Care Hospital Laboratory: Potential for Significant Cost Savings

2019 ◽  
Vol 51 (3) ◽  
pp. 320-324
Author(s):  
Sumedha Kulkarni ◽  
Dina Piraino ◽  
Rachel Strauss ◽  
Eva Proctor ◽  
Suzanne Waldman ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Cost Savings ◽  
International Normalized Ratio ◽  
Total Annual Cost ◽  
Care Hospital ◽  
Order Entry ◽  
Significant Cost ◽  
Laboratory Errors ◽  
The Cost ◽  
Analytical Errors

Abstract Background Preanalytical errors account for most laboratory errors. Although the frequencies of preanalytical errors are well characterized in the literature, little is known regarding the costs of these errors to the laboratory. Objective To analyze costs associated with preanalytical errors associated with the international normalized ratio (INR) test. Methods We performed a retrospective analysis of INR requests associated with preanalytical error codes from January 2009 through September 2013. Preanalytical error types were those related to order entry (no specimen collected) and those unrelated to order entry (insufficient specimen quantity or specimen-integrity concerns). We calculated the cost of analysis of a specimen and the cost of investigating errors. Results During the study period, there were 557,411 INR requests, 13.1% of which were associated with a preanalytical error code. The total annual cost of INR testing was USD $379,222.50. Investigation and reporting of preanalytical errors not related to order entry represented 10.5% of our annual INR testing budget (USD $39,939.00). Conclusions Minimizing preanalytical errors has the potential to result in significant cost savings.

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